30275 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY QF CUPF,RTINO _ BUILDING-ELECTRICAL PERMIT NO.
BUu,gING DIVISION BUILDING
PLUMBING.-MECHANICAL,
BUILDING.PROJECT'IDENTIFICATION '302.75
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
0o 7�q -96
OWNER'S NAME: oe PH E. CON711tICTORS , E: ICN
NIC CON'T'ROL#
ARCHITECT/ENGINEER: LIC NO: ADDRESS: ❑ ��
PHONE
p:�— BUILDING PERMI'i INFO
41^YJ ❑ Consultant Fees Paid by Applicant(Initial) BhDG fir UMB MECH
Pd~
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
I hereby#from mpro
al I am licensed ander vi.ioa,of Chiral9(commencing JOB DESCRIPTION
HOZ withSection]OW)of Division3oflhe Business an Probisrions Cede.andmy license is RESIDENTIAL:
FW. full Come and dfccl.//ff PERMIT ISSUANCE
FaUU License Cle"_f„2—Lia# ❑SFUWL ❑KITCHEN REMODEL
NQd Umc Cantmnor APPLIANCES—RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
F,P y ARCHITECT'S DECLARA > PANELS ❑MULTI-UNIT ❑STRUCfURAL
Z p h Z I undemund my plans,ball Fo a Jas public records MODIFICATION
O" a UPT0200AMPS []INTERIOR DCHIMNEY REPAIR
H-& :;W Licensed Profe,sInitial 2UI-IBfMILAMPS IMPROVEMENT
`ww-,j OWNER-BUILDERDE Ce CmartON OVER II]IOOAMPS ❑BATH REMODEfIREPAIR []DEMOLITION
Q I hereby nfrnn Ilial]um exonpl Goth the Conuacna'z License Law for the
3 a F. following reason.(Section 7031,5,Business and Professions Csde:Any city or county SIGNS ELECTRICAL ❑OTHER
LL OWN¢ which requires a pemul m comuun,aper.Improve,denmlixh,or repair any wmeturc
F'�ymJ Prior to its issuance,also requires the applicant for such permit n fde a signed statement SPECIAL CIRCUIT/MISC.
C'7y Qf that he is licensed pa,uanun the provisions ofine Chummier's License Law(Chapter 9
W 0o (commencing vshb Section 7(xxq of Division 3 of me Business and Professions Crash)or TEMP.NIET17R OR POLE INST.. COMMERCIAL:
C.6 c tY that he is exempt therefrom and the basis for the alleged exemption.Any violation of
kq LL Sanion703L5b El NEW BLDG/ADDITION ❑DEMOLI'T'ION
tU�m yhundre doll 0501mthsubjecls the applieonue ueivll penalty of POWER DEVICES []TENANT ❑FOOD SERVICE
FQOf more Than five hundred dollars 18500).
I,as owner elite ,,arm IMPROVEME
❑ progeny, yemntended with nemei((Sec.
compensation, SWIMMING POOL ELECTRIC /
_so
will dotheand linestructureachanot s Liver,ornB'e does .,il(Or up,],1.an Business ❑ TH'R l
a 3 m and Profession Code:The Canvherea Lind o law Jsys not apply s if owner of OUTLETS—SWITCHES—FIXTURES
prnpeny who bullJx or improves thcmun,and who does such work himself m Ilwugh
his own employee,,provided that such imprn,comas are not immadeJ nr offered for NEW RESIDENTIAL.ELECTR SQ FT
sale.If,howevernhebuildingnrimprnvemeniissnld witurone year ofcomplainn,lhe SQ.IT.FL OR AREA
senor-builder will have the burden of proving that he did not build or improve for pur-
pose of sale.).
❑1,as owner of the progeny,am exclusively contracting with licensed contractors to TOTAL:
construct the project(Sec.7041,Business and Professions Codes The Can.mcor's Li-
censeL.wdoes all applyman nwnur of fopeny who buildsmimproves marcor,and QTY, PLUMBING PERMIT r FEE
who contracts for such project with a contmaogs)licertd pursuant o the Comracmrs AAUG �� ��
License Law. PERMIT ISSUANCE PI C
❑I nm exempt under See. ,B&P C fur this exam, O
Owner Dam 1E .
AIN&VENT_WA'1'ER CEA) ,s1 t ;VALUATION
WORKERS COMPENSATION DECLARATION "' 1 like
PROTECT.DEVICE
I berebyntf n under penalty of perjury one of the Calms ing declarations
❑Ihave and will maintain#Certificate of Consent ms<If-insure for Workers Cheaper-
ROOF.ROOF.AREA,COND. STORIES
TYPE CONSTRUCtION
smirch,as pan,Wesl for by Section 3710 of the Labor Coda,for the perfmmancc of the
work for which this Perot reissued. PER TRAP
❑1 have and will maintain W'mker.s Compensation Insurance,as required by Section
3700 of the later Code,for the peroununcc of me work for which this permit is issued. STEM-1 INC.4 OUTLETS OCC GROUP APN
My Workers Compensation Insurance carrier and Policy number arc:
Carrier Policy No.: STEM-OVER 4(BA)CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE USTRI.WASTE INTISRCEPTOR
(this section need not he completed if the permit is for one hundred cholla,(S100) BUILDING DIVISION BEES
or less) Gk1iASE TRAP PLANCHECK FEE
Loy any perhat in the pey man necofthe work lieswhich this permit lsirsmad.I shall Cheper- SEWER—SANITARY—STORM EA.200 F"E
not employ uny person in any man as e�sybysuo the Workers'Cheaper- ENERGY FEE
O Z satin.Lawn ojy� rriya.Doc n�� Y/
O Applicant J�a.[� WATER HEATER WNENT/GLELTR
Z = GRADING FEE
NOTICE T�At K :IL a0 r making this Cer ificam of Exemption,you should WATER SYSTI3M?kEATING
a ; become subject m the Worker's Compensation provisions of the Labor Code,you muss SOILS FEE
Lkl forthwith comply with such provisioner this permit shall be em
deedrevoked. WATER SERVICE.
aQ
5Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL CLOTH. SQ.FT. PAID
I hereby.frrm shot them iso section lending agency[ur me perfarmuncc of Data Receipt OF
the work for which this ,.it is i 1,.1097,Civ.C.
Lenders Name )
W4Lender's Address 7 'TOTAL: TOTAL:
r0. I canny that 1 have read this application and stare that One above information is
N nBUILDING FEB
corrcn.l#goon mvsmply with all city and county and sum laws rclming m QTY. MECHANICAL PERMIT FEE
V Z building consortium.and hereby mora eapmw.t.ti,aa of do,caym cnmrufm the SEISMIC FEE
above-mentioned progeny for in,pectinn purryrsn. PERMH'ISSUANCE
(We)agree m save,indemnify and keep hamkss the City of Collection against ELECTRIC FEE
Iiabilities.judgmems,coats and expenses which may in any way uceme against said City ALTER Ok ADU'fO MECH.
in nsequunce of the gramin,of this permit. PLUMBING FEE
APPLICANT INDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO.fX01 CPM)
SOUR, UL TIONS, MECHANICAL FEE
O =1 As AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
gtgnutura odApplacilsanuormarchor Dam EXHAUST HOOD(W/DUCE l
HA]ARDOUS MATERIALS DISCLOSURE I HOUSING MITIGATION M.
Will meapplach a ftatrcbuildivg uccupammore or handle heramous mammal HEATING UNIT(TO 100.000 BTU)
os defined by the Cupertino Municipal Code,Chapter 9.12,and me Health and Safety
Colo Scamin 25532(#)7 srrs��k�'��' HE'A'PING UNIT'(OVER 100.IXID BTU)
❑Yes 1RINo
�/\h VENTILATION PAN(SINGLE RESID) PAID
WIII the air consnror fmu building occupant use equipment or devices which Data Receipt p
milha>adous air ronuminants as defined by the Bay Arta Air Quality Management BOILER—COMP(3HP OR 100,000 BTU). TOTALI
�Nn BOILER—COMP(OVER IOO,IpO BTU)
real lhehoomous nmmnals lryuimmems anhr Chafer 6.95 of the Cali- AIR CONDITIONER
&Safny C�dc.Sections 25505,25533 and 25534.1 undertand that if the ISSUANCE DATE
nol a Ifr{mve a ranunI in til is my rcspnmibilirymnotify the acupanl NEW RES]DEN'HAL M ECH. SQ.FT.
urr flt tMmel p' cofa�enificem offkcupancy.an
goal Ilam - O
ISSUED BY: • ✓VYr l
OFFICE
TR9
1 SANTA CLARA COUNTY
CONTROL NUMBER
CENTRAL FIRE PROTECTION DISTRICT
14700 WINCHESTER BOULEVARD BUILDING PERMIT NUMBER
LOS GATOS, CA 95030-1818 (408)378-4010 LA9 6-21 2 7
�fCTION PN REVIEW NUMBER
SERVICE SINCE 1947 FAX(408)378-9342
PLAN REVIEW COMMENTS
CODEtSEC. SHEET NO. REQUIREMENT
Review of shaft for the Type I ventilating exhaust hood.
1. No additional coments.
System already installed and inspected.
APPROVED: Okay to issue permit.
DISTRICT PLANS SPECS NEW RMDL AS OCCUPANCY CONST.TYPE PERMITTEE
DATE PAGE
CUP ® ® ❑ El 08/14/96 1 1
SECJFLOOR AREA LOAD DESCRIPTION -OF_
AML BV
New Fire Protection Meisenbach, Teresa
.JAME OF PROJECT
LOCATION
SAMRAT FINE INDIAN CUISINE 20956 Homestead Rd
Proudly Serving Santa Clara County and the Cities of:
Campbell, Cupertino, Monte Sereno, Morgan Hill,
Saratoga and the Town of Los Gatos
SEP 07 '96 12:07PM CONSUMER PROTECTION P.22
SANTA CLARA COUNTY ENVIRONMENTAL HEALTH SERVICES '
2220 Moorpark Ave. 660 S.Fair Oaks Ave. 16450 Monterey Rd. 1650-K Las Plumas Ave.
San Jose, CA 95128 Sunnyvale, CA 94086 Morgan Hill,CA 95037 SaEl n Jose,CA 95133
WNAMf
RECHECK DATE
ADDRESS/LOCATION pI---756 t-,W
MAILING ADDRESS `
EUPLOTEEO SERVICE
PROORALVELEMENT LOCATION CODE TIME WORK AREA
REPORT OF OBSERVATIONS'.
NSA
1:01e LO,f
t7e
• -RECEIVED BY i 1
EGAy6�/
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